MESENTERIC ARTERIOPORTAL SHUNT AFTER HEPATIC-ARTERY INTERRUPTION

Background. Massive hepatic necrosis from hepatic artery (HA) interrup tion is a complication after extended pancreatobiliary operation. The effectiveness of a mesenteric arterioportal shunt in preventing liver failure after massive hepatic necrosis was evaluated. Methods. Of 98 p atients who underwent pancreatic or hepatic resection for pancreatobil iary carcinoma between January 1989 and December 1995, six received a mesenteric arterioportal shunt. Clinical and hemodynamic analyses were done retrospectively. Results. The six patients were classified into groups: A, postoperative hepatic arterial occlusion and, B, main HA ex cision without reconstruction. One patient in group A and three patien ts in group B had good arterioportal shunt patency and favorable clini cal courses. However, fatal hepatic necrosis after ligation of the HA proper occurred in one patient in group A from small portal flow despi te a presumed patent shunt. In another patient in group A angiogram re vealed shunt occlusion. Conclusions. A mesenteric arterioportal shunt is beneficial when massive hepatic necrosis has occurred or is expecte d after main HA interruption under such conditions as postoperative he patic arterial occlusion or HA excision without reconstruction. The pr ocedure has the advantages of appropriate selection of artery size, a lower abdominal site apart from the primary operative field, and easy shunt closure by transarterial embolization.